Pain relief and EMS

[firedoc5]

The one thing that we didn't carry in the field that I wished we had was Demerol. But on the other hand, if the word got out on the street that we carried it, we'd have to have security around the clock to prevent break ins.

[fireflymedic]

For us here's our choices

FOR PAIN

toradol

dilaudid

morphine

fentanyl

FOR ANXIETY/SEDATION

fentanyl

ativan

versed

valium

use diprivan on transports frequently

etomidate

here it's take your pic and choice the drug box - it's more medic's choice and liking and the situation so there's a variety of flavors

[JPINFV]

But in there defense, they rarely had more than a 3 min. ETA.

What defense? 3 min ETA and then how long before you get a bed and how long after that is it going to be until the hospital can assess and start pain control? Next time one of your coworkers gives you that line break their hip and then don't issue them pain control.

Oh, and it's good to hear that your new crop of medics are giving better pain control.

[firedoc5]

What defense? 3 min ETA and then how long before you get a bed and how long after that is it going to be until the hospital can assess and start pain control? Next time one of your coworkers gives you that line break their hip and then don't issue them pain control.

Oh, and it's good to hear that your new crop of medics are giving better pain control.

Something I consistently saw with the previous generation(s) of Medics was the hesitation of pain control and actual treatment of pts. Some wouldn't even start a hep-lock or IV, none the less give medication. During that time everyone knew there needed to be some major changes. When those changes came down making Medics to be more aggressive in their treatment, I'd say 40% either quit or just dropped back down to Basic. They didn't want that responsibility. (Pretty sad, I know) This was during the very early '80's, and it was about that time more classes like mine started to produce Medics that were willing to be more intervening and aggressive. That's one reason I've said that in the mid-80's we started to come along way.

Fortunately for the pts., but the local ER's were fairly quick in getting a pt. in a lot of pain assessed and given meds. Many times I've heard ER staff say "It's Medic so & so, you know he won't have anything done in the field." When I started to hear those kind of things I told myself that no one would ever accuse me of that.

[WolfmanHarris]

Entonox used to be on the Ambulances in Ontario (as per my instructor) and isn't anymore. Couldn't tell you why.

[BushyFromOz]

Something I consistently saw with the previous generation(s) of Medics was the hesitation of pain control and actual treatment of pts. Some wouldn't even start a hep-lock or IV, none the less give medication. During that time everyone knew there needed to be some major changes. When those changes came down making Medics to be more aggressive in their treatment, I'd say 40% either quit or just dropped back down to Basic. They didn't want that responsibility. (Pretty sad, I know) This was during the very early '80's, and it was about that time more classes like mine started to produce Medics that were willing to be more intervening and aggressive. That's one reason I've said that in the mid-80's we started to come along way.

Fortunately for the pts., but the local ER's were fairly quick in getting a pt. in a lot of pain assessed and given meds. Many times I've heard ER staff say "It's Medic so & so, you know he won't have anything done in the field." When I started to hear those kind of things I told myself that no one would ever accuse me of that.

Its funny you mention thid, when i work with well seasoned collesgues i am sometimes pulled up for being too aggressive in treatment. I frequently place IV's in patients tha i will not be giving any IV meds to based solely on having my options open should they deteriorate. I prefer not to use our analgesic gas and try straight for the morph if i can. this is considered "over the top" by some, especially those that believe that "less is best" ALWAYS applies. Ill hand out aspirin to patients who just have a history that i cant make any sense out of "just in case" it was a cardiac event (what im a going to lode, 3c worth of aspirin??)

the older guys tend to say the patient didn't really need it, the clinical department say good thinking , it can make some shifts very fruustrating

[AMESEMT]

I didn't vote, but here are our options where I work as an ALS provider. We carry for pain:

Nitrox

Fentanyl

Morphine

Demerol

I personally like to give the fentanyl. It seems like it is more effective as easing the pain versus the morphine, and without the drop in BP. Two days ago I had a patient that slipped on the ice and had obvious deformity to the left wrist. I gave her fentanyl and her pain went from 9/10 to 4/10.

[Camulos]

The medication options for analgesia here are;

1) Entonox : Seems to work well on minor injuries. It is bulky to transport and has to be used with caution in trauma, particularly if pneumothorax or bowel injury is suspected.

2) Penthrane : Unusual drug in my experience. Seems to be no middle ground – It either works really well or doesn’t work at all. Usually works well in kids. I noted a previous comment on this thread regarding the adverse effects of penthrane – particularly its nephrotoxicity. All of these studies were done when penthrane was administered at an anaesthetic dose. When administered in its analgesic dose there have been no reports of this. The advantages of penthrane are that it is small and easy to carry to remote or difficult to access locations. You can also concurrently administer oxygen through the base of the inhaler however some services have banned this practice, particularly when administering in confined spaces.

3) Morphine : Fantastic medication!!! Works well in most situations. What more can you say.

4) IN Fentanyl : Also a fantastic medication. Studies have shown no real difference in efficacy between morphine and fentanyl. Easy to deliver, particularly if you stuff up the IV cannula and cannot give the morphine.

Some prehospital services here also utilise paracetamol and ibuprofen if appropriate.

I particularly like an earlier answer on this thread that highlighted that there are more pain relief options than just medication alone – splinting, positioning, ice (the cold type not the street type – LOL), reassurance etc. I believe it is important that we are all mindful of this and use everything we have available to ensure our patient’s pain is treated appropriately. Most of the studies report we do a poor job of treating pain therefore definitely an area for improvement.

Stay safe,

Curse :evil:

[tniuqs]

Any one use Toradol aka Ketorolac ?

I was going to dump it from my remote stuff but have learned that it is very effective for renal colic patients, where in past, I would go straight to Fent or MS, live and learn from others.

Thanks to Larry, Donn and Dust.

No one has said anything about eyes ... any Pontocaine or Marcaine out there in upside down world ?

cheers

[chbare]

Diclofenac and Tramadol administered via parenteral routes are drugs of the year over here. I agree that Toradol has great properties; however, the side effect and caution profile for this med is substantial. Like most NSAID's GI complications are going to be a concern and the effects on the renal system must also be considered.

I would not be a big advocate of using Pontocaine in the field. The safety profile does not justify using it IMHO. Especially due to the fact that our ability to treat and recognize ophthalmic conditions is quite limited.

Take care,

chbare.